A Smartphone App to Assess Alcohol Consumption Behavior: Development, Compliance, and Reactivity

Abstract

Background There are disadvantages—largely related to cost, participant burden, and missing data—associated with traditional electronic methods of assessing drinking behavior in real time. This potentially diminishes some of the advantages—namely, enhanced sample size and diversity—typically attributed to these methods. Download of smartphone apps to participants’ own phones might preserve these advantages. However, to date, few researchers have detailed the process involved in developing custom-built apps for use in the experimental arena or explored methodological concerns regarding compliance and reactivity. Objective The aim of this study was to describe the process used to guide the development of a custom-built smartphone app designed to capture alcohol intake behavior in the healthy population. Methodological issues related to compliance with and reactivity to app study protocols were examined. Specifically, we sought to investigate whether hazard and nonhazard drinkers would be equally compliant. We also explored whether reactivity in the form of a decrease in drinking or reduced responding (“yes”) to drinking behavior would emerge as a function of hazard or nonhazard group status. Methods An iterative development process that included elements typical of agile software design guided the creation of the CNLab-A app. Healthy individuals used the app to record alcohol consumption behavior each day for 21 days. Submissions were either event- or notification-contingent. We considered the size and diversity of the sample, and assessed the data for evidence of app protocol compliance and reactivity as a function of hazard and nonhazard drinker status. Results CNLab-A yielded a large and diverse sample (N=671, mean age 23.12). On average, participants submitted data on 20.27 (SD 1.88) out of 21 days (96.5%, 20.27/21). Both hazard and nonhazard drinkers were highly compliant with app protocols. There were no differences between groups in terms of number of days of app use ( P =.49) or average number of app responses ( P =.54). Linear growth analyses revealed hazardous drinkers decreased their alcohol intake by 0.80 standard drinks over the 21-day experimental period. There was no change to the drinking of nonhazard individuals. Both hazard and nonhazard drinkers showed a slight decrease in responding (“yes”) to drinking behavior over the same period. Conclusions Smartphone apps participants download to their own phones are effective and methodologically sound means of obtaining alcohol consumption information for research purposes. Although further investigation is required, such apps might, in future, allow for a more thorough examination of the antecedents and consequences of drinking behavior.

Development and Acceptability of a Method to Investigate Prescription Drug Misuse in Daily Life: Ecological Momentary Assessment Study

“…The results indicated some evidence of reactivity to the momentary reporting procedure, as has been found in reporting other substances using EMA approaches (eg, alcohol) [ 32 ]. It is possible that participants were more attentive to the procedure at the beginning of their reporting periods and, therefore, were more likely to endorse misuse intentions in daily life earlier on during reporting.…”

“…Although reported behavior instances might be lower if the device was not readily available to the participant, the responses obtained may be more forthright due to security and privacy assurances. Nevertheless, in light of the recent successful apps on young adults’ own smartphones to assess drinking in daily life [ 32 , 39 ], this study provides a foundation for the next steps in adapting the study of prescription drug misuse in daily life to different designs. Future work could examine such possibilities.…”

Notifications to Improve Engagement With an Alcohol Reduction App: Protocol for a Micro-Randomized Trial (Preprint)

“…Our primary aim is to improve engagement with the app, and future research can investigate whether any effectiveness is mediated through engagement. Importantly, research into effective strategies to collect real-time outcomes on substance abuse through other apps is emerging [50][51][52], including an MRT with an "engagement-first" strategy to increase the rate of self-reported data [53]. This research is a valuable step towards developing more effective behavior change apps.…”

Development and Acceptability of a Method to Investigate Prescription Drug Misuse in Daily Life: An Ecological Momentary Assessment Study

“…Consistent with numerous EMA protocols on addictions [30][31][32][33], both signal-and event-contingent assessments were administered [34]. Signal-contingent reporting involved a device prompt (ie, a notification) 4 times a day, once during each of the following periods: 8:00 AM to 11:30 AM, 11:30 AM to 3:00 PM, 3:00 PM to 7:00 PM, and 7:00 PM to 11:00 PM.…”